Are changes to the CAT definition catastrophic?

The 2015 Ontario budget contained provisions which will allow for significant cuts to the minimum level of Statutory Accident Benefits that insurance companies offer to their customers.

On May 14, 2015, the Ministry of Finance released the proposed changes to the definition of catastrophic impairment.

The chart below summarizes the proposed changes to the benefits and the definition as compared to the present definition and level of benefits.

Many of these recommendations stem from the 2011 Superintendent's Report to the Minister of Finance.

While we applaud the automatic designation of CAT for children it is noteworthy that the Superintendent's commentary in the Executive Summary on this issue suggests that this measure is warranted as it can help reduce stress on families: To quote the report:

"The Panel noted that a long period of waiting for a final determination could impose unnecessary stress on families. Automatic designation would give claimants immediate access to the appropriate benefits. Furthermore, due to the fact that assessments would no longer be needed, this approach should reduce assessment and other transaction costs to the insurance system."

We would argue that families feel the same level of stress waiting for a final determination on catastrophic impairment whether they are dealing with a severely injured child or a severely injured adult. Not to ever diminish the trauma and stress in dealing with an injured child, however with the case of an adult, who may be the sole breadwinner for a family, it could even be argued that stress is even more compounded while waiting for a determination on catastrophic impairment in that case.

One of the other recommendations in the Superintendent's recommendation was interim catastrophic benefits for people who "unequivocally require intensive and prolonged rehabilitation". Certainly if one is going to have to wait a period of time before catastrophic determination this might act as beneficial safeguard to individuals being left without necessary care and medical treatment. The notion of interim catastrophic funding is absent from the May 14, 2015 news release and if this is no longer being considered it is disappointing and detrimental to seriously injured accident victims.

Clearly the most startling definition change is the elimination of the GSC score eligibility. This appears problematic for several reasons, first it eliminates a simple way to get severely injured people into the catastrophic category from the outset, as opposed to waiting a prescribed period of time when one can administer the GOS-E. It also eliminates a very simple and cost effective way to determine catastrophic impairment as opposed to the more involved and costly assessments in the other categories.

It must always be remembered that persons with catastrophic injuries do not automatically get a cheque for $1,000,000.00 just because they are deemed catastrophic - it simply raises the ceiling of benefits, these individuals still need to prove that they are entitled to the benefits that are sought under the policy and that those benefits are both reasonable and necessary.

According to the May 14, 2015 news release comments are being accepted on the proposed changes to the policy until June 29, 2015. If you are an accident victim or a stakeholder group it is extremely important to have your say on these important issues. If you do have something to say, consider contacting your local MPP or signing this petition https://www.change.org/p/ontario-mpps-finance-minister-charles-so usa-stop-reducing-ontario-accident-benefits to have your voice heard.

This blog post was written by Gluckstein Personal Injury Lawyer Angela Comella.